NCPA - National Center for Policy Analysis

Providing Improved Care Management for Medicare/Medicaid Dual-Eligible Beneficiaries

June 14, 2012

Dual eligibles, those qualified for Medicare and Medicaid coverage, often fall into a fragmented care delivery system that perpetuates episodic rather than coordinated care, say Grace-Marie Turner, president of the Galen Institute, and Robert Helms, a research scholar at the American Enterprise Institute.

That these patients are often neglected within the system is compounded by the fact that they are often those who are most in need.

  • More than 9 million Medicaid recipients (15 percent) are dual eligibles, yet they account for 39 percent of Medicaid spending.
  • On average, total spending for duals, including Medicare and Medicaid contributions, is twice as high as that for non-duals ($28,518 compared to $14,204).
  • Most dual eligibles have very low incomes, substantial health needs, and are more likely to live in nursing homes compared to other beneficiaries.
  • Long-term care services account for 69 percent of Medicaid expenditures for dual eligible.

In order to free up care for these dual eligibles, and to create a system that spends money more efficiently, Turner and Helms propose "Medicaid Advantage" -- a new institution charged with the coordinated care of dual eligibles.  The program's goals are stated as follows:

  • Integrate acute and long-term care benefits into a single program they would oversee in which competing private plans (or the states) would provide a coordinated care management program for dually-eligible beneficiaries.
  • Streamline cumbersome rules governing marketing, enrollment, performance monitoring, quality reporting, rate setting, bidding, and grievances and appeals.
  • Eliminate redundant and inefficient spending.
  • Achieve savings through innovative policies, such as disease management and care coordination.
  • Provide both the federal and state governments more predictability in budgeting for the significant part of their Medicare and Medicaid spending on dual eligibles.

By synchronizing the care of Medicaid and Medicare, Turner and Helms hope to achieve superior health outcomes with lower government spending.  Crucial to these efficiency gains will be authoritative control at the state -- rather than federal -- level, where program administrators can more closely coordinate with private plan operators.

Source: Grace-Marie Turner and Robert Helms, "Providing Improved Care Management for Medicare/Medicaid Dual-Eligible Beneficiaries," American Enterprise Institute, May 7, 2012.

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